How Should I Decide on a Residential Treatment Center?

The process of deciding to seek residential treatment for a substance use disorder can be terrifying, daunting and confusing. Despite the slowly growing cultural tolerance towards those in recovery from drugs or alcohol, the idea that you may personally need rehab can evoke feelings of desperation and failure.   

This could be especially true if you have previously gone through treatment and it did not “work” for you. If you are a loved one trying to assist someone struggling, you may feel equally confused and bewildered. How do you sift through the countless websites for various treatment centers in order to make an informed decision

What are the right questions to be asking during this trying time, when it is a matter of life and death? How do you make a decision this important? What if it does not work? And why did treatment not work before?  

What questions should you ask a treatment center?

When considering which facility to entrust with the care of your loved one and their path towards sobriety, it is important to gather information related to: 

  1. A treatment center’s philosophical approach to treatment
  2. The therapeutic strategies employed and the training level of clinicians administering the treatment
  3. The percentage of individual versus group therapies, and what are the therapeutic elements of the program
  4. Treatment center’s approach towards medication management
  5. Specific details on how the family system is incorporated in the treatment experience (how much time is spent on family therapy, how do they assess the family’s readiness, how is family work individualized)
  6.  Treatment philosophy and services offered for dual-diagnosis (or co-occurring mental health/trauma)
  7. How “success” is measured in the program
  8. How is length of the stay in the program is determined

These are just a few considerations that should be taken into account when determining if a treatment center offers the “best fit” for you or your loved one.

What is their approach to treatment?

Many programs are 12-step based, meaning they derive their treatment curriculum from the fundamental principles of the 12-step program, for example, those found in Alcoholics Anonymous. As a result, in some treatment programs, clients are often required to participate in 12 step programming as a critical component of the treatment experience. However, some individuals experience an aversion to the language and philosophy associated with this model, thus it is very important to inquire how a treatment center might approach these concerns.  

What is the staff training level?

Many facilities will provide a list of the type of therapies their clinicians are trained to implement; for example, cognitive behavioral-based treatment, mindfulness-based practices, somatic-based therapies, EMDR, and/or dialectical behavioral therapy. Assessing the number of clinicians at the facility that are dually-licensed (for both substance abuse and mental health) may be an important indicator of the clinicians’ ability to conceptualize and treat the complex interplay between mental health and substance use issues.  

It may also be beneficial to discover what the ratio is for clinical staff to clients, as well as understand the breakdown of the multi-disciplinary team. Does the primary therapist providing care to the clients have at least a master’s level degree and are they fully licensed (as opposed to accruing hours as a supervisee)? How frequently will the client meet with a physician? Are there other holistic providers that are considered a part of the staff? What is their level of training and expertise in their respective areas? Does the treatment team operate collectively, or does it appear that each is serving their individual agendas?

What does their weekly programming consist of?

Asking for the specific number of hours a week that a client will be working one on one with an individual therapist can be an important indicator of the opportunities for individualized programming. Many programs may place a heavier emphasis on group therapy over individual therapy and/or supplemental activities. Depending on the length of your stay at a residential level, it’s important to consider whether programs that favor group modalities will sufficiently target the root of the often unconscious and self-protective defenses many clients have acquired over the years. In particular it is important to consider whether you consider the depth of connection with a therapist as an important factor in facilitating change.  

Another area for consideration involves the structure and content of the groups. Are groups primarily didactic (psycho-educational) versus process-focused, are there skill-based groups, are groups interactive or lecture-based? What are the basic qualifications and level of training of the individuals facilitating the groups as opposed to peer-led groups? If group programming composes the majority of the treatment experience, it feels highly important that you’re intentional about selecting a treatment center whose groups are structured in a way that will most likely engage your interests or style of learning. It’s an unfortunate reality that many people do not really find themselves learning new content if groups are structured in a way that does not account for the unique challenges and participants of the clients who are attending.  

What are the policies related to medication management?

Will all clients be evaluated by a psychiatrist? How does the facility handle medication management? How is the role of medications contrasted with what can be facilitated with intensive therapy? What is the approach to medications that are considered “controlled substances?’ What is the stance towards medications intended for relapse prevention? What type of medications are maintained and which are considered problematic for long term use?  

Medication management is a very important part of the treatment process; however, facilities vary greatly in their approach and their emphasis on medications. Many clients can go through treatment to address a substance use disorder but remain on medications that can have problematic concurrent risk potential. Sadly, in some instances, medications can be used to replace the efforts of staff and clinicians to put in place alternative coping strategies that actually teach clients how to feel what is a necessary part of the healing and self-discovery process.

What does family involvement look like?

Oftentimes when treating substance use disorders, there is, understandably, one person that takes primary focus, the individual seeking treatment. We have come to appreciate, however, that without addressing one’s family and social support system the likelihood of a successful outcome dramatically declines. It is important to recognize family involvement as essential, but family work can take many forms.  Good questions for consideration involve: How will my family/support system be evaluated for participation, how is the family’s role in the healing process conceptualized and explained, and how will they be prepared to be supportive to their loved one with respect to their own concerns? What does the “family program” look like, or what does the “family weekend” involve? Will the family be directly involved in therapy or primarily be receiving one-directional education? 

Do they offer treatment for dual diagnosis?

Fortunately, many treatment centers have evolved to recognize the critical importance of widening the treatment lens to include co-occurring mental health concerns. However, there is still a persisting inclination for some facilities to have certain clinicians that are licensed to only treat “substance use issues” while a different set of clinicians focus on “mental health.” More concerning are treatment environments that require a referral outside of the facility to treat “mental health issues.” As a treatment consumer, this is a critical element to differentiate, as the interplay between substance abuse and mental health symptoms can be a key factor in understanding why some clients become perpetually stuck in a cycle of relapse.  

Another element to consider involves the treatment center’s level of expertise in addressing co-occurring psychiatric disorders and even how they conceptualize the intersection between addiction and mental health. In particular, there is growing awareness of the critical necessity for effective treatment of co-occurring or underlying trauma that so often runs parallel to persistent substance use cycles. There are very specific interventions for treating co-occurring trauma that critically inform a clinician’s ability to understand the incredibly complex and often self-limiting emotional processes that accompany trauma related struggles. For example, inquiring of a facility the ways in which they therapeutically identify, address, and treat shame can be a revealing indicator of their sophistication in addressing a very nuanced and powerful paralytic for many people who continue to suffer.  

How do they measure their success?  

It is understandable that concerned family members often weight a treatment programs’ abstinence rates as heavy marker of treatment success or efficacy. Some websites will advertise extraordinarily high “success” rates; however, it is important to consider several questions that allow you to more critically evaluate this data and these claims. How does a facility ensure accuracy of the data obtained and what percentage of the residents are completing this data post treatment? Are there other metrics of success that serve as important indicators of change? Is success determined based on the evaluation of the client? On the family? On whether they use substances again? Is abstinence the only goal of treatment? Complicating things further, some programs may promote their treatment formula as the “cure” for substance use disorder which can cause even more frustration and hopelessness when treatment “does not work.” 

Why We’re Different – Treatment at The Manor

We at The Manor subscribe to an understanding of addiction that is not limited solely to the brain disease model. We conceptualize substance use disorders as a complex and heartbreaking attempt for many individuals to tolerate the world, seek relief, and escape their pain. In this regard, substances can temporarily allow you to feel more comfortable in your own skin and with other people. Simply providing education about the harms of use and a prescription for modifying one’s behavior, does not sufficiently reach or inspire change for many of our clients. Becoming sober is incredibly hard work.  We deeply respect the ways in which our clients have learned to protect themselves from the change that is so desperately needed. If the solutions to this maddening cycle were simple there would be no need for residential treatment.  

Rather we make it our mission to understand the unique barriers and stuck points that each client encounters. This is only facilitated through earning deep and meaningful therapeutic connections. For this reason, we place a strong emphasis on individual therapeutic work with at least six individual session hours occurring weekly. We also believe in the power of group therapy when facilitated with a lens that creates intimacy, trust, and cohesion. Group therapy can sometimes create opportunities for understanding yourself in relationships in ways that can be profoundly impactful. The point is that we use the connections that you build with your peers and your therapists to more deeply understand the relationship patterns that have been contributing to your feeling stuck and unhappy.  

Again, it is in these conversations that clients begin to reconnect with who they feel they are most authentically. By pulling back certain expectations about self– without substances, without unnecessary medications, without distractions– individuals can begin to learn to both discover and like who they are. They may develop the capacity to enjoy themselves and others for the first time without being altered. They can begin to replace and repair the story they’ve told themselves for so long, and rest instead in a new narrative, that they are worthy of love and belonging.

 On a daily basis, we are inspired by the resilience and courage of our clients. This is how we at The Manor measure success: after years of hiding, clients can begin to explore what most scares them, recognize the power of their own vulnerability, and live with a level of transparency that is rarely found in most of the general population, sober or not. This is why we have so much respect for our clients and the bravery they demonstrate in the treatment process.

We aim to be as helpful as possible in the process of assisting you in finding the best possible care for yourself or your loved one. If you have any questions about any of the above-mentioned topics, please feel free to reach out to us today at 414.930.1930!

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